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Diuretics work better than newer therapies in hypertension


Thiazide-type diuretics remain the drugs of choice for initial therapy of high blood pressure in both black and non-black patients.

Death related to hypertension and the risk of end-stage renal disease ( ESRD ), coronary heart disease ( CHD ), heart failure ( HF ), and stroke are increased in the black compared with the white population in the United States.
There is little cardiovascular outcome data for blacks with hypertension treated with the common therapies of angiotensin-converting enzyme ( ACE ) inhibitors or calcium channel blockers ( CCBs ).

An analysis of ALLHAT evaluated whether antihypertensive regimens initiated with a CCB ( Amlodipine ) or an ACE inhibitor ( Lisinopril ) is superior to a thiazide-type diuretic ( Chlorthalidone ) in reducing CVD incidence in racial subgroups.

ALLHAT ( The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ) is a randomized, double-blind, clinical trial which compared high blood pressure medications.
ALLHAT was conducted between February 1994 and March 2002 in 33,357 hypertensive U.S. and Canadian patients aged 55 years or older ( 35 percent black ) with at least 1 other cardiovascular risk factor.

Participants took either Amlodipine ( Norvasc ), Lisinopril ( Zestril ), or Chlorthalidone. Other medications were added to achieve goal blood pressures less than 140/90 mmHg.

The study concludes that diuretics are either similar or superior to newer drugs in lowering blood pressure, in tolerability, and in preventing the major complications from high blood pressure.

Across both racial subgroups, there was substantially higher risk of heart failure ( 37 percent ) among participants taking calcium channel blockers compared with those on diuretics.

When compared with ACE inhibitors, diuretics were more effective in preventing cardiovascular disease, especially heart failure, for all participants and significantly more effective in reducing high blood pressure and preventing stroke in blacks.

Based on this study finding, the authors conclude that as the initial drug for treating high blood pressure, ACE inhibitors work less well than alternatives in black patients.

Source: Journal of American Medical Association , 2005

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